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| | __NOTOC__ |
| '''For patient information click [[Anorexia nervosa (patient information)|here]]''' | | '''For patient information click [[Anorexia nervosa (patient information)|here]]''' |
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| {{Infobox_Disease
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| | Name = Anorexia Nervosa
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| | Image =
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| | Caption =
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| | DiseasesDB = 749
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| | ICD10 = {{ICD10|F|50|0|f|50}}-{{ICD10|F|50|1|f|50}}
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| | ICD9 = {{ICD9|307.1}}
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| | ICDO =
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| | OMIM = 606788
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| | MedlinePlus = 000362
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| | MeshID =
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| }}
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| {{Anorexia nervosa}} | | {{Anorexia nervosa}} |
| | '''Editor(s)-in-Chief:''' [[C. Michael Gibson]], M.S.,M.D. [mailto:charlesmichaelgibson@gmail.com]; {{AE}} {{KS}} |
| | ==[[Anorexia nervosa overview|Overview]]== |
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| '''Editor(s)-in-Chief:''' [[C. Michael Gibson]], M.S.,M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Mark Warren, MD, MPH; Fellow, Academy of Eating Disorders [mailto:mwarren@eatingdisorderscleveland.org]
| | ==[[Anorexia nervosa historical perspective|Historical Perspective]]== |
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| ==Diagnosis and clinical features== | | ==[[Anorexia nervosa classification|Classification]]== |
| The most commonly used criteria for diagnosing anorexia are from the [[American Psychiatric Association|American Psychiatric Association's]] [[Diagnostic and Statistical Manual of Mental Disorders]] (DSM-IV-TR) and the [[World Health Organization|World Health Organization's]] [[ICD|International Statistical Classification of Diseases and Related Health Problems]] (ICD).
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| Although biological tests can aid the diagnosis of anorexia, the diagnosis is based on a combination of behavior, reported beliefs and experiences, and physical characteristics of the patient. Anorexia is typically diagnosed by a [[clinical psychologist]], [[psychiatrist]] or other suitably qualified clinician.
| | ==[[Anorexia nervosa pathophysiology|Pathophysiology]]== |
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| Notably, diagnostic criteria are intended to assist clinicians, and are not intended to be representative of what an individual sufferer feels or experiences in living with the illness.
| | ==[[Anorexia nervosa causes|Causes]]== |
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| The full [[ICD-10]] diagnostic criteria for anorexia nervosa can be found [http://www3.who.int/icd/currentversion/fr-icd.htm?gf50.htm+ here], and the [[DSM-IV-TR]] criteria can be found [http://www.behavenet.com/capsules/disorders/anorexia.htm here].
| | ==[[Anorexia nervosa differential diagnosis|Differentiating Anorexia Nervosa from other Diseases]]== |
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| To be diagnosed as having anorexia nervosa, according to the DSM-IV-TR, a person must display:
| | ==[[Anorexia nervosa epidemiology and demographics|Epidemiology and Demographics]]== |
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| # Refusal to maintain [[human weight|body weight]] at or above a minimally normal weight for age and height (e.g., [[weight loss]] leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
| | ==[[Anorexia nervosa risk factors|Risk Factors]]== |
| # Intense fear of gaining weight or becoming [[overweight|fat]].
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| # Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
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| # In postmenarcheal, premenopausal females (women who have had their first menstrual period but have not yet gone through [[menopause]]), [[amenorrhea]] (the absence of at least three consecutive menstrual cycles).
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| # Or other eating related disorders.
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| Furthermore, the DSM-IV-TR specifies two subtypes:
| | ==[[Anorexia nervosa screening|Screening]]== |
| * ''Restricting Type'': during the current episode of anorexia nervosa, the person has not regularly engaged in [[binge-eating]] or purging behavior (that is, self-induced vomiting, over-exercise or the misuse of [[laxative]]s, [[diuretic]]s, or [[enema]]s)
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| * ''Binge-Eating Type or Purging Type'': during the current episode of anorexia nervosa, the person has regularly engaged in binge-eating OR purging behavior (that is, self-induced vomiting, over-exercise or the misuse of laxatives, diuretics, or enemas).
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| The [[ICD|ICD-10]] criteria are similar, but in addition, specifically mention
| | ==[[Anorexia nervosa natural history, complications and prognosis|Natural History, Complications, and Prognosis]]== |
| # ways that individuals might induce weight-loss or maintain low body weight (avoiding fattening foods, self-induced vomiting, self-induced purging, excessive exercise, excessive use of appetite suppressants or diuretics);
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| # physiological features, including "widespread [[endocrine]] disorder involving [[hypothalamus|hypothalamic]]-[[pituitary]]-[[gonad]]al axis is manifest in women as [[amenorrhoea]] and in men as loss of sexual interest and potency. There may also be elevated levels of [[growth hormone]]s, raised [[cortisol]] levels, changes in the peripheral [[metabolism]] of [[thyroid]] hormone and abnormalities of insulin secretion"; and
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| # if the onset is before puberty, development is delayed or arrested.
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| ===Presentation=== | | ==Diagnosis== |
| There are a number of features, that although not necessarily diagnostic of anorexia, have been found to be commonly (but not exclusively) present in those with this eating disorder.<ref name="GowersBryant-Waugh2004">Gowers S, Bryant-Waugh R. (2004) Management of child and adolescent eating disorders: the current evidence base and future directions. ''J Child Psychol Psychiatry'', 45 (1), 63-83. PMID 14959803</ref><ref name="LaskBryant-Waugh2000" />
| | [[Anorexia nervosa diagnostic criteria|Diagnostic Criteria]] | [[Anorexia nervosa history and symptoms|History and Symptoms]] | [[Anorexia nervosa physical examination|Physical Examination]] | [[Anorexia nervosa laboratory findings|Laboratory Findings]] | [[Anorexia nervosa electrocardiogram|Electrocardiogram]] | [[Anorexia nervosa other imaging findings|Other Imaging Findings]] | [[Anorexia nervosa other diagnostic studies|Other Diagnostic Studies]] |
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| ====Psychological====
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| * Distorted [[body image]]
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| * Poor insight
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| * Self-evaluation largely, or even exclusively, in terms of their shape and weight
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| * Pre-occupation or [[obsessive-compulsive disorder|obsessive]] thoughts about food and weight
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| * [[Perfectionism (psychology)|Perfectionism]]
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| * [[OCD]] (obsessive compulsive disorder)
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| * belief that control over food is synonymous with being in control of one's life
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| ====Emotional====
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| * Low [[self-esteem]] and [[self-efficacy]]
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| * [[Clinical depression]] or chronically low mood
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| * Intense fear about becoming overweight
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| * Moodiness or 'mood swings'
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| ====Interpersonal and social====
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| * Withdrawal from previous friendships and other peer-relationships
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| * Deterioration in relationships with the family
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| * Denial of Basic needs, such as food
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| ====Physical====
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| * Extreme weight loss
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| * Stunted [[puberty|growth]]
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| * [[Endocrine]] disorder, leading to cessation of periods in girls ([[amenorrhea]])
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| * Decreased [[libido]]; [[impotence]] in males
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| * Starvation symptoms, such as reduced [[metabolism]], slow heart rate ([[bradycardia]]), [[hypotension]], [[hypothermia]] and [[anemia]]
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| * Growth of [[lanugo]] hair over the body
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| * Abnormalities of mineral and [[electrolyte]] levels in the body
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| * [[Zinc]] deficiency
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| * Often a reduction in [[white blood cell]] count
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| * Reduced [[immune system]] function
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| * [[Body mass index]] less than 17.5 in adults, or 85% of expected weight in children
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| * Possibly with pallid [[complexion]] and sunken eyes
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| * Creaking joints and bones
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| * [[Tooth decay]]
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| * Collection of fluid in ankles during the day and around eyes during the night
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| * [[Constipation]]
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| * Very dry/chapped lips due to malnutrition
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| * Poor circulation, resulting in common attacks of 'pins and needles' and purple extremities
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| * In cases of extreme weight loss, there can be nerve deterioration, leading to difficulty in moving the feet
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| * Headaches, due to malnutrition
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| * Thinning of the hair
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| * Nails become more brittle
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| * Constantly feeling "cold"
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| * Bruise easily
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| * Dry skin
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| ====Behavioral====
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| * Excessive exercise, food restriction
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| * [[Fainting]]
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| * Secretive about eating or exercise behavior
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| * Possible [[self-harm]], [[substance abuse]] or [[suicide]] attempts
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| * Very sensitive to references about body weight
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| * Become very aggressive when forced to eat "forbidden" foods
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| ===Diagnostic issues and controversies===
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| The distinction between the diagnoses of anorexia nervosa, [[bulimia nervosa]] and [[eating disorder not otherwise specified]] (EDNOS) is often difficult to make in practice and there is considerable overlap between patients diagnosed with these conditions. Furthermore, seemingly minor changes in a patient's overall behavior or attitude (such as reported feeling of 'control' over any bingeing behavior) can change a diagnosis from 'anorexia: binge-eating type' to bulimia nervosa. It is not unusual for a person with an eating disorder to 'move through' various diagnoses as his or her behavior and beliefs change over time.<ref name="GowersBryant-Waugh2004"/>
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| Additionally, it is important to note that an individual may still suffer from a health- or life-threatening eating disorder (e.g., subclinical anorexia nervosa or [[eating disorder not otherwise specified|EDNOS]]) even if one diagnostic sign or symptom is still present. For example, a substantial number of patients diagnosed with EDNOS meet all criteria for diagnosis of anorexia nervosa, but lack the three consecutive missed menstrual cycles needed for a diagnosis of anorexia.<ref name="LaskBryant-Waugh2000"/>
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| Feminist writers such as Susie Orbach and Naomi Wolf have criticised the [[medicalisation]] of extreme dieting and weight-loss as locating the problem within the affected women, rather than in a society that imposes concepts of unreasonable and unhealthy thinness as a measure of female beauty.
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| ==Prognosis==
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| Anorexia is thought to have the highest mortality rate of any psychiatric disorder, with approximately 6% of those who are diagnosed with the disorder eventually dying due to related causes.<ref>{{citation|first1 = David B|last1 = Herzog|first2 = Dara N|last2 = Greenwood|first3 = David J|last3 = Dorer|first4 = Andrea T|last4 = Flores|first5 = Elizabeth R|last5 = Ekeblad|first6 = Ana|last6 = Richards|first7 = Mark A|last7 = Blais|first8 = Martin B|last8 = Keller|title = Mortality in eating disorders: A descriptive study|journal = International Journal of Eating Disorders|volume = 28|number = 1|pages = 20-26|year = 2000}}</ref> The suicide rate of people with anorexia is also higher than that of the general population and is thought to be the major cause of death for those with the condition.<ref>Pompili M, Mancinelli I, Girardi P, Ruberto A, Tatarelli R. (2004) Suicide in anorexia nervosa: a meta-analysis. ''Int J Eat Disord'', 36 (1), 99-103. PMID 15185278</ref> A recent review suggested that less than one-half recover fully, one-third improve, and 20% remain chronically ill.<ref>Steinhausen HC. (2002) The outcome of anorexia nervosa in the 20th century. ''Am J Psychiatry'', 159 (8), 1284-93. PMID 12153817.</ref>
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| ==Treatment== | | ==Treatment== |
| The [[first line treatment]] for anorexia is usually focused on immediate weight gain, especially with those who have particularly serious conditions that require [[hospitalization]]. In particularly serious cases, this may be done as an [[involuntary commitment|involuntary hospital treatment]] under [[mental health law]], where such legislation exists. In the majority of cases, however, people with anorexia are treated as [[outpatient]]s, with input from [[physician]]s, [[psychiatrist]]s, [[clinical psychologist]]s and other mental health professionals.
| | [[Anorexia nervosa medical therapy|Medical Therapy]] | [[Anorexia nervosa primary prevention|Primary Prevention]] | [[Anorexia nervosa secondary prevention|Secondary Prevention]] | [[Anorexia nervosa cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Anorexia nervosa future or investigational therapies|Future or Investigational Therapies]] |
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| A recent clinical review has suggested that [[psychotherapy]] is an effective form of treatment and can lead to restoration of weight, return of [[menses]] among female patients, and improved psychological and social functioning when compared to simple support or education programmes.<ref>Hay P, Bacaltchuk J, Claudino A, Ben-Tovim D, Yong PY. (2003) Individual psychotherapy in the outpatient treatment of adults with anorexia nervosa. ''Cochrane Database Syst Rev'', 4, CD003909. PMID 14583998.</ref> However, this review also noted that there are only a small number of [[randomised controlled trial]]s on which to base this recommendation, and no specific type of psychotherapy seems to show any overall advantage when compared to other types. [[Family therapy]] has also been found to be an effective treatment for adolescents with anorexia<ref>Lock J, Le Grange D. (2005) Family-based treatment of eating disorders. ''Int J Eat Disord'', 37 Suppl, S64-7. PMID 15852323.</ref> and in particular, a method developed at the [[Maudsley Hospital]] is widely used and found to maintain improvement over time.<ref>Le Grange D. (2005) The Maudsley family-based treatment for adolescent anorexia nervosa. ''World Psychiatry'', 4 (3), 142-6. PMID 16633532.</ref>
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| It is important to note that many recovering underweight people often harbour a hateful dislike for those who they feel to be robbing them of their treasured emaciation. Often when well-meaning friends or relatives compliment the recoveree on how much healthier they look, the recoveree's mind replaces "healthy" with "fat".
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| Drug treatments, such as [[SSRI]] or other [[antidepressant]] medication, have not been found to be generally effective for either treating anorexia,<ref>Claudino AM, Hay P, Lima MS, Bacaltchuk J, Schmidt U, Treasure J. (2006) Antidepressants for anorexia nervosa. ''Cochrane Database Syst Rev'', 1, CD004365. PMID 16437485.</ref> or preventing relapse<ref>Walsh BT, Kaplan AS, Attia E, Olmsted M, Parides M, Carter JC, Pike KM, Devlin MJ, Woodside B, Roberto CA, Rockert W. (2006) Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial. ''JAMA'', 295(22), 2605-12. PMID 16772623.</ref> although it has also been noted that there is a lack of adequate research in this area. It is common, however, for antidepressants to be prescribed, often with the intent of trying to treat the associated anxiety and depression.
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| Supplementation with 14mg/day of zinc is recommended as routine treatment for anorexia nervosa due to a study showing a doubling of weight regain after treatment with zinc was begun. The mechanism of action is hypothesized to be an increased effectiveness of neurotransmission in various parts of the brain, including the [[amygdala]], after adequate zinc intake begins resulting in increased appetite.<ref>Birmingham CL, Gritzner S (2006) How does [[zinc]] supplementation benefit anorexia nervosa? ''Eating and Weight Disorders'', 11 (4), e109-111. PMID 17272939</ref>
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| There are various non-profit and community groups that offer support and advice to people who have anorexia, or are the carer of someone who does. Several are listed in the links below and may provide useful information for those wanting more information or help on treatment and medical care.
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| ==See also==
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| * [[History of anorexia nervosa]]
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| * Adi Barkan (photographer who has campaigned against use of anorexic models)
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| * [[Anorexia (symptom)]]
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| * [[Body dysmorphic disorder]]
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| * [[Body image]]
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| * [[Bulimia nervosa]]
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| * [[Binge eating disorder]]
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| * [[Cachexia]]
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| * [[Calorie restriction]]
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| * [[Defensive vomiting]]
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| * [[Eating disorder]]
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| * [[Eating disorder not otherwise specified]]
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| * Female body shape
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| * [[Malnutrition]]
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| * [[Muscle dysmorphia]] ('reverse' anorexia nervosa)
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| * [[Orthorexia nervosa]]
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| * [[Pro-ana]]
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| * [[Purging disorder]]
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| * [[Refeeding syndrome]]
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| * [[Wannarexia]] — a term for people who want to be anorexic
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| ==References==
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| {{Reflist|2}}
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| | ==Case Studies== |
| | [[Anorexia nervosa case study one|Case #1]] |
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| [[Category:Psychiatry]] | | [[Category:Psychiatry]] |
| [[Category:Eating disorders]] | | [[Category:Eating disorders]] |
| [[Category:Overview complete]]
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| [[Category:Endocrinology]] | | [[Category:Endocrinology]] |
| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
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| [[ar:خلفة ذهنية]]
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| [[bg:Анорексия нервоза]]
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| [[ca:Anorèxia nerviosa]]
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| [[cs:Anorexie]]
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| [[da:Anoreksi]]
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| [[de:Anorexia nervosa]]
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| [[et:Anoreksia]]
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| [[es:Anorexia]]
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| [[eo:Anoreksio]]
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| [[fr:Anorexie mentale]]
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| [[gd:Fuath-bìdh]]
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| [[gl:Anorexia nerviosa]]
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| [[hr:Anoreksija]]
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| [[id:Anorexia nervosa]]
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| [[is:Lystarstol]]
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| [[it:Anoressia]]
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| [[he:אנורקסיה נרבוזה]]
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| [[ku:Anoreksiya nervoza]]
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| [[hu:Anorexia nervosa]]
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| [[nl:Anorexia nervosa]]
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| [[ja:神経性無食欲症]]
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| [[no:Anorexia nervosa]]
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| [[pl:Jadłowstręt psychiczny]]
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| [[pt:Anorexia nervosa]]
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| [[ru:Нервная анорексия]]
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| [[simple:Anorexia nervosa]]
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| [[sl:Nervozna anoreksija]]
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| [[sr:Анорексија нервоза]]
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| [[fi:Anoreksia]]
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| [[sv:Anorexia nervosa]]
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| [[tr:Anoreksiya nervoza]]
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| [[uk:Анорексія]]
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| [[zh:神经性厌食症]]
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| {{WH}}
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| {{WS}}
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